This invention relates to a novel bandaging system and, more particularly, to the treatment of wounds such as exuding leg ulcers, for which the treatment protocol requires bandaging and the application of compressive pressure.
Since the invention is particularly directed to the treatment of leg ulcers, it will be best understood by reference thereto.
In general, the treatment regimen for leg ulcers includes the combination of the application of a medicament and compression.
It is well known in the art to apply a dressing known in the art as "Unna's Boot" for treatment of leg ulcers. Unna's Boot is a bandage impregnated with a paste that includes zinc oxide and gelatin and has the consistency of a soft plaster of paris bandage which does not set to a firm cast. The zinc oxide can be beneficial to the irritated skin and is often applied for this purpose.
Since the application of compressive pressure is also known to be beneficial to the treatment of leg ulcers, the Unna's Boot is wrapped under compression around the leg in the area of the ulcer.
The Unna's Boot is often overwrapped with an elastic or cohesive bandage to provide additional compression and to protect the paste bandage.
While Unna's Boot is generally useful in the treatment of leg ulcers, if applied properly, and with noncompliant patients does serve the additional function of making it extremely difficult for the patient to gain access to the ulcer and cause harm, it does suffer from certain significant disadvantages.
One major disadvantage is that it produces varying compression levels due to the human factor of individuals employing different techniques in applying the bandage. In other words, it takes a great deal of practice and skill to consistently apply the proper compression levels when wrapping the dressing.
Another problem is the inability to apply proper graduated compression levels when wrapping the dressing. Applying pressure gradients has been shown to be superior to uniform pressures when treating venous ulcers. Unna's Boot dressings inherently provide irregularities of bandage compression levels which do not retain the pressure and, consequently, one must rely on subjective application to provide a graduated compression.
Moreover, application of a Unna's Boot dressing is messy and time-consuming. The dressing should be changed at least weekly and this cannot normally be done by the patient at home. Consequently, the patient is typically required to visit a hospital or clinic on an out-patient basis to do this.
For these reasons, the clinician or practitioner has explored alternatives to the use of Unna's Boot. These include various types of primary and secondary dressings in contact with the ulcer and leg with compression applied by alternative means. One such alternative is the use of elastic bandages to apply compression. However, a basic problem with elastic bandages again is the variability of compression applied by the individual wrapping the leg. Another significant disadvantage is that the elastic bandages tend to slip due to normal movements of the patient and consequently do not retain their position as originally applied.
A possible viable solution to the problem is the use of elastic stockings such as those commercially available from The Kendall Company, assignee of the instant invention. Such stockings will provide the proper pressure gradient for treatment of the venous disorder. As illustrative of these elastic stockings, mention may be made of those described and claimed in U.S. Pat. No. 4,745,917 issued to James H. Hasty.
However, elastic stockings are not usually employed with ulcers that have not healed, since the stockings are difficult to apply over a dressing and may stain with ulcer exudate unless additional absorbent materials are placed over the primary dressing. On the other hand, the use of a primary dressing with an overlying absorbent secondary dressing further materially increases the difficulty in putting on the elastic stocking over these primary and/or secondary dressings.
In summary, from the standpoint of applying the proper compression and the ease of doing so, the use of the known elastic stockings offers the best approach to providing the compression for treating leg ulcers. However, the difficulty in putting the stocking on over the dressing applied to the unhealed ulcer makes their use for treating unhealed ulcers generally impractical.
It is to this problem that the present invention is directed. Stated simply, the task of this invention can be stated to be to find a practical way to use the known elastic stocking technology in combination with a dressing for treatment of venous leg ulcers.